Individual
MS. ANALISE KATHRYN LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
103 MEDICINE WAY ROAD, PERIDOT, AZ 85542
(928) 475-1340
(928) 475-7370
Mailing address
P. O. BOX 787 - 0787, PERIDOT, AZ 85542
(928) 475-1340
(928) 474-7370
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2510
AZ
363A00000X
Physician Assistant
3811
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
624959
—
AZ
Enumeration date
03/24/2006
Last updated
03/07/2023
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